<div class="layuimini-container">
    <form id="app-form" class="layui-form layuimini-form">
        <div class="layui-form-item">
            <label class="layui-form-label">代理商名称</label>
            <div class="layui-input-block">
                <input type="text" name="title" disabled class="layui-input" lay-verify="required"
                       placeholder="请输入代理商名称"
                       value="{$row.title|default=''}">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">代理商电话</label>
            <div class="layui-input-block">
                <input type="text" name="mobile" disabled class="layui-input" lay-verify="required" placeholder="请输入电话"
                       value="{$row.mobile|default=''}">
            </div>
        </div>

        <div class="layui-form-item">
            <label class="layui-form-label">提现金额</label>
            <div class="layui-input-block">
                <input type="number" name="partner" class="layui-input" lay-verify="required" placeholder="请输入提现金额"
                       value="">
                <tip>填写提现金额</tip>
            </div>
        </div>

        <div class="hr-line"></div>
        <div class="layui-form-item text-center">
            <button type="submit" class="layui-btn layui-btn-normal layui-btn-sm" lay-submit>确认</button>
            <button type="reset" class="layui-btn layui-btn-primary layui-btn-sm">重置</button>
        </div>

    </form>
</div>
